Blumenthal: Meaningful use charged health IT market
 | |
| David Blumenthal, MD, MPP, professor of health policy, Harvard Medical School, Boston. |
“A great majority of those products are produced by companies with fewer than 15 employees. In other words, the meaningful use framework has transformed the market for EHR solutions in a way that is going to fundamentally change the way information is managed in the U.S.,” Blumenthal claimed.
Major technology vendors as well as "garage innovators" are entering into the EHR IT market space, Blumenthal said, and that is one of the more important changes brought about by the meaningful use framework. In that sense, the meaningful use framework will help to create exports that “will have enormous value for job creation and for our economy," he added.
Returning to Massachusetts after two years heading the Office of the National Coordinator for Health IT under President Barack Obama, Blumenthal spoke on healthcare reform, his accomplishments in Washington, D.C. and the challenges that remain.
“Health reform is a series of mountains,” Blumenthal said: "Every time you get to one peak, you get a new vision and see new peaks."
"[The HITECH Act] was always going to be a multiyear, maybe even multidecade, project, but we got off to a promising start when the law was passed because the law was very clear that the aspiration was about healthcare change and not technology,” Blumenthal stated. “The most important tool that the legislation created, and the most important asset that the ONC had to begin work with, was the very orientation of the legislation.”
The act also clearly addressed the critical barriers of promotion of a Nationwide Health Information Network, including the financial barrier to health IT adoption and its use for exchange of health information. The absence of incentives to improve performance in healthcare generally had profound effects on the IT market because there were no incentives to adopt health IT.
Blumenthal also noted there were psychological barriers such as fear of technology from healthcare providers and general anxieties attributed to the psychological aspect of change.
Another barrier was the lack of the capability for creating exchange. “HIE is a team sport…You can be the Tom Brady of health IT but unless you have a receiver down the field to receive what you want to send, you may as well hang up your cleats,” Blumenthal stated.
The last and somewhat underrated barrier is the assurance of privacy and security of health information, according to Blumenthal. There’s always a story in the media—whether about a retail store or hospital—about the absence of sufficient security. “In the case of health IT, that is a critical problem in terms of earning and maintaining the public’s trust,” he said.
Under meaningful use, there is reasonable acceptance of the framework as a useful, social apparatus. “The process of setting up of, discussing the regulations creates an opportunity for public discussion of how information should be used for healthcare. We’ve never had that kind of discussion before.”
Blumenthal shared that when he left Washington in April, there were 36,000 providers who had registered as meaningful users. Medicaid had already paid out $64 million to 500 providers as of the beginning of April.
“May 18 is when I’m told Medicare expects the first payments to meaningful users to roll out,” added Blumenthal.
There are now 67,000 providers registered with the 62 regional extension centers, whose 62,000 members are primary care physicians who are part of small practices (those with 10 or fewer employees). Sensing a shift in the tides toward positive health IT adoption, Blumenthal concluded that adoption will be successful but healthcare reform will not be without challenges.
The adoption of EHRs will be successful, but a much more difficult task will be the actual exchange of clinical information, he said.
According to Blumenthal, creating an effective exchange and going past that milestone requires conditions of trust and interoperability; a political and technical challenge. “It requires standards, protocols and policies and technologies for exchange but also strong consensus of privacy and security guarantees.”
“I don’t know of any more challenging leadership problem in the U.S. healthcare system right now. Challenging not only because it involves highly sensitive and personal things that the American people care deeply about, but also because it involves highly technical considerations. Because there are issues of time, because there are issues of performance, failures can be crippling to the trust that is required to make the system work,” Blumenthal concluded.